Study after study shows that almost all people don’t take their prescribed medications. It doesn’t matter what they’re – statins, medicines for hypertension, medicines that lower blood sugar levels, asthma medications. Patients either don’t start using them in any respect or stop using them.
It’s an issue that doctors call nonadherence — the universal human tendency to withstand treatment — and which results in countless deaths and billions of dollars in preventable medical costs each yr.
But this resistance might be overcome because of the blockbuster obesity drugs Wegovy and Zepbound, which have amazed the world with the best way they assist people drop some pounds and keep it off. Although it continues to be early days and there’s a paucity of knowledge on the usage of recent drugs, doctors say they’re noticing one other surprising effect: patients appear to be taking them faithfully, week after week.
Some patients could have to beat their initial reluctance to begin treatment. A nationwide study found that when people were told they might gain weight in the event that they stopped using drugs, most lost interest in starting.
In one small study, patients stopped refilling their prescriptions for several months, perhaps because of unwanted effects, lack of availability, or insurance and cost issues.
However, anecdotally, doctors and patients say that those that start taking the drugs proceed to take them.
“I have no intention of ever stopping this medication,” said Kimberly DelRosso of Pembroke, Massachusetts, who takes Wegovy.
She never forgot to take her weekly injection. In contrast, she says, she often neglected to take her prescribed blood pressure pills when she weighed more. (Now, after losing a few pounds with Wegovy, I do not need them anymore.)
For now, doctors report that, like Ms. DelRosso, most of their patients intend to take their obesity medications eternally, and many are delighted once they now not need other medications.
Dr. David Cummings, professor of drugs on the University of Washington and director of the burden management program on the VA Puget Sound Health Care System, records his patients’ experiences with Wegovy and the diabetes drug Ozempic. So far, he has prescribed medications to about 1,000 patients. At most 5 percent stopped due to unwanted effects, he said. Others stopped because their insurance now not covered their drug or they couldn’t discover a pharmacy that had the drug in stock, reflecting persistent drug shortages.
But those that stop generally don’t accomplish that voluntarily, he said. Other doctors who prescribe Wegovy agreed.
“Adherence is exceptional,” said Dr. Diana Thiara, medical director of the burden management program on the University of California, San Francisco. “People take it. They ask for additions. They take him on trips.”
An epidemic of non-compliance
Is Price to be paid for neglecting to take prescription medications. An astonishing 40 to 50 percent of individuals prescribed medications for chronic conditions like hypertension or diabetes don’t take them, leading to $100 billion in preventable medical costs each yr. This lack of compliance is estimated to steer to no less than 100,000 preventable deaths each yr.
Even a heart attack might not be enough to scare people into turning to the present arsenal of heart medications which were shown to stop heart disease deaths. Some research shows that it’s just that half individuals who had a heart attack were still taking heart-protective medications two years later.
“These patients have seen the bright lights, gone by ambulance, undergone emergency PCI, had secondary heart attacks in their families, seen the Pearly Gates, but still don’t seem to be taking statins and beta-blockers,” said Amitabh Chandra, professor of public policy and business administration at Harvard.
Even doctors stop taking medications, contradicting the hypothesis that individuals accomplish that because they do not likely understand their importance.
And while cost plays a task, no less than one test found that even when medications are free, adherence might be dismal.
One reason appears to be a type of ingrained reluctance to take something that reminds people each day that they’re sick or that many patients would notice. Especially with what experts call “forever” drugs, taking them each day makes some patients feel abnormal.
“People think they feel fine so they don’t need medication,” said Corrine Voils, a social psychologist on the University of Wisconsin who studies medication adherence. “But this medicine keeps them healthy.”
Jalpa A. Doshi, professor of drugs on the Perelman School of Medicine on the University of Pennsylvania, said patients make their very own personal value judgment: “The drug has side effects, requires a co-pay, and just taking the pill reminds me that I’m sick.” But I haven’t any symptoms – I do not see hypertension or high cholesterol.”
“And what are the benefits?” she added. “I really don’t see the benefit. “I could eat less salt and fatty foods and walk and exercise more” – instead of taking these medications.
The mental assessments patients make “make it much easier to quit,” Dr. Doshi said.
That describes Mark Anthony Walker, 61, of Dublin, California, whose experience with heart disease casts a shadow over a troubling family history – his father died of a massive heart attack at the age of 47 and his mother at the age of 48.
At age 26, Mr. Walker had a cholesterol level of 360.
“I was terrified,” he said.
Since then he has taken statins on and off and is now on one. But I don’t plan on taking it forever. He concluded that his brain needed cholesterol. As for using drugs for the rest of his life, “I’m completely against it,” he said.
Instead, he believes he will be able to control his heart disease and even reverse it with a rigorous diet, exercise and vitamins.
Mr. Walker’s cardiologist, Dr. David J. Maron, director of preventive cardiology at Stanford University, gently encourages him and others like him to take their medications. But as doctors know, if they start storming with fire, their patients will simply go elsewhere.
Less stigma, less shame
So what can make obesity medications different? First, although doctors typically recommend medications such as statins or blood pressure medications, patients often ask their doctors for obesity medications. Many people have tried every diet and exercise program they could find throughout their lives, and every time they lost weight, they gained it back.
Moreover, people who start taking new obesity medications will find it difficult to hide when they stop taking them: the lost weight may return along with the stigma, shame and guilt that often accompany obesity. This makes these medications very different from most others.
“You don’t get a big sign on your chest saying, ‘Blood pressure medication stopped,’” said Dr. Walid Gellad, a professor of medicine at the University of Pittsburgh who studies medication adherence.
The downside, however, is that obesity medications are expensive and often require doctors to fill out cumbersome forms before agreeing to insurance. There is a constant shortage of drugs throughout the country. These obstacles can make them difficult to achieve.
Other disadvantages of the drugs include side effects such as nausea and gastrointestinal problems, as well as the way they are administered – patients must inject the drugs once a week.
IN test at the Cleveland Clinic, Hamlet Gasoyan and colleagues reviewed the electronic health records of 402 patients at sites in Ohio and Florida who were taking the obesity drugs Wegovy or Ozempic. They found that only 161, or 40 percent, consistently refilled their prescriptions during the year. Side effects, availability, or insurance and cost issues may have played a role.
But there’s a reason why patients willingly call dozens of pharmacies looking for medications and, as faithfully as possible, inject themselves every week: without obesity, they feel they look better and are perceived differently. They are no longer rejected or shamed. People no longer stare at a shopping cart or comment while eating a bowl of ice cream. The embarrassment, self-blame and endless stigma of obesity is gone.
This is an important factor for Ms. DelRosso.
Obese people “are treated in a different way,” she said, adding: “It’s terrible how people disregard you due to your weight.”
But it also impresses with its health effects. She no longer suffers from sleep apnea or high blood pressure, and her blood sugar levels, which were approaching diabetic levels, have dropped.
“I don’t have to take any medications anymore,” she said.
Except, in fact, Wegovy.
